Monthly Archives: August, 2008

Fast-Tracking Fasting

The term “fasting”  brings up different meanings to different people.To some it holds spiritual significance whether they are Jews, Christians, Hindus or Muslims. To others, it is done on a purely physical level, the main benefit being that of healing, where the body is allowed to rest and rehabilitate, thereby flushing out toxic wastes which have been allowed to accumulate.In fact, fasting has often been called  the single greatest natural healing therapy. To most, fasting is both spiritual and physical.

Whatever the reasons and objectives, there are proper ways to optimise the health benefits, in my opinion. In response to some readers’ queries on eating healthily, below are some pointers for otherwise healthy folks. Bear in mind that, in the context of medical conditions like diabetes, kidney or heart failure, advice from your care-giver is important.

In view of the long hours of fasting, one should consume slow digesting foods including fibre containing-foods rather than fast-digesting foods. Slow digesting foods last up to 8 hours, while fast-digesting foods last for only 3 to 4 hours.

· Slow-digesting foods are foods that contain grains and seeds like barley, wheat, oats, millet, semolina, beans, lentils, wholemeal flour, unpolished rice, wholemeal bread,capati,naan,etc. (they are also called complex carbohydrates).

· Fast-burning foods are foods that contain sugar, white flour, etc. (called refined carbohydrates).

One should avoid:

· Excessive fried and fatty foods which will create indigestion and ‘wind’.

· Foods containing too much sugar when commencing the fast. This may cause ‘rebound hypoglycemia’ and cause a feeling of hunger and giddiness.

· Too much tea or coffee when commencing the fast. They makes you pass more urine, taking with it valuable mineral salts that your body would need during the day in addition to causing dehydration.

· Smoking cigarettes. If you cannot give up smoking, cut down gradually starting a few weeks before commencing the period of fasting.

Try to eat:

· Complex carbohydrates before commencing fasting so that the food lasts longer making you less hungry.

· Dates when breaking the fast as they are an excellent source of sugar, fibre, carbohydrates, potassium and magnesium to replace that lost during fasting.

Try to drink:

· As much water or fruit juices as possible in the hours before commencing the fast so that your body may adjust fluid levels in time.This helps to prevent dizziness in the afternoon due to low blood pressure as a result of dehydration.

· One tall glass of water at the commencement of fast to minimise dehydration.

Cutting Healthcare Costs Without Cutting Corners (Part 1)- Buy Generic

In these recessionary and inflationary times, there are strategies that can be taken to minimise expenditure related to health without compromising on accessibility and efficacy.

One method is to fill your prescriptions with generic drugs rather than branded ones. Simply put, this means buying medications which have completed their patent license (the ‘copyright period’ so to speak when the  company that discovered the drug has the sole right of production,usually ten years) from manufacturers other than the original company, the so-called generic manufacturers. This often brings tremendous cost-savings especially for those who are uninsured and have to pay out-of-pocket. The main reason generic drugs are cheaper is because the cost of research and development (R&D) is negated.

Plavix - an essential blood-thinner for many with heart disease

Indeed, the savings can be considerable. Take for instance the anticholesterol drug Zocor (chemical name simvastatin) whose patent rights expired in 2006 and the blood-thinner Plavix (clopidogrel) whose patent also expired recently. Both these drugs can be bought at up to 50% savings now that several generic manufacturers have commenced producing it.

The big disclaimer is that the generic drugs must be obtained from reputable generic manufacturers where their purity and efficacy are similar to the original. This is often measured via bioequivalent studies by reputable bodies such as the US FDA(Food and Drug Administration). Talk to your professional adviser and be guided accordingly.

As is often the case, there are many forgeries and low-end generics with doubtful bioequivalence available on the market – just check your spam email box to see the multitude on offer 😦   Caveat emptor!*

(*Latin for “let the buyer beware”)

Hospitals Deporting People – a Human Rights Issue?

Judging from  recent news reports, quite a number of US hospitals are resorting to deporting patients who have been stabilised but have nowhere to go. This applies particularly to illegal immigrants who are uninsured and unable to financially support themselves.

Hospitals caught in a Catch-22 situation

To highlight an example, the New York Times recently reported of a 35 year-old  Guatemalan patient who came to the US illegally and was knocked down by a car 8 years ago in Florida. A community hospital saved his life, twice, and, after failing to find a rehabilitation center willing to accept an uninsured patient, kept him in the ward for years at a cost of US$1.5 million. During a prolonged legal battle, the hospital decided on its own to charter an air ambulance and fly the patient back to Guatemala, wheelchair and all, on the basis that this would be less expensive in the long run.  Not so fortunate is, another patient,  a 30 year old Mexican who is being deported by a hospital while in coma. Read about it here.

This case exposes a little-known but apparently widespread practice. Many American hospitals are taking it upon themselves to repatriate seriously injured or ill immigrants because they cannot find nursing homes willing to accept them without insurance. Medicaid covers emergency care (to some extent) but does not cover long-term care for illegal immigrants. However, hospitals are obligated by law to arrange for post-hospital care.

Still, human rights activists are understandably outraged –“there is something wrong with the system when the bottom line is more important than a human life”.

Hospital authorities counteract by saying – ” We are running a business. Someone has to pay for it at the end of the day. Besides, we have gone out of our way to send these patients back at our own expense. All of this is done legally – what about the felony charges against illegal aliens?”

My take on this is that the whole world is faced with limited resources especially in healthcare. Which is why in an earlier post (read here ), I predict that many countries will soon have to come to accept that :

..basic healthcare is a basic human right.

For Those Studying Medicine..(1)

Paracelsus - not an ancient Greek/Roman physician but a 16th century Swiss doctor

The art of medicine cannot be inherited, nor can it be copied from books…. – Paracelsus


Some readers aspiring to become doctors, aka medical students, asked if I had any tips, so this is an appropriate one to start with. Yes, to become a good doctor does not mean cramming in the library all the time. It is a profession dealing with unwell people, and above all, it has all to do with communicating with a fellow human being. And this is best done when you’re in the field, in this case, by the bedside.

Never forget that it is not a pneumonia, but a pneumonic man who is your patient, to borrow the words of William Gull.

The Effect of Alcohol..on squirrels, sight and sex

The Malaysian Tree Shrew - the World's Heaviest Drinker

Next to the Olympics, another set of records were quietly being publicised over newspapers and blogs around the world. This relates to the ability of one of nature’s creatures being able to imbibe the equivalent of one case of beer every night without getting drunk!

The Malaysian tree shrew, belonging to the squirrel family and the size of a small rat was featured in a local newspaper recently here. The animal was also featured in countless newspapers throughout the world ( here’s onethe world’s heaviest drinker) and also in several blogs ( tiny malaysian tree shrews live on alcohol but never gets drunk). What’s the secret? These animals have an unusual metabolism that can convert alcohol quickly into nontoxic ethyl glucuronide (EtG).This stuff EtG is deposited into the animal’s fur, out of harm’s way. Human beings are unable to do this.

The progressive effects of alcohol on humans have been well-documented. One of the more well-known is that as one imbibes, there is a perception that  people around you become increasingly attractive. This was confirmed in a recent study by the University of Bristol which gives more credence to this phenomenon, called beer-goggles. The following humorous video illustrates the effect of too much booze and its ill consequences:

Which brings us to the effect of alcohol on sex – its been widely believed that alcohol has aphrodisiac properties. This is a fallacy as all it does is to lower inhibitions and raises irrational behaviour. In fact, taken regularly , it is a known to even cause erectile dysfunction. Even William Shakespeare knew of its effect when the porter in Macbeth said words to the effect that:

“Alcohol increases the desire but diminishes the performance”.

Look forward to hear from those of you who drink!

Pardon the Sleep…its OSA!

Picture these four situations:

  1. Have you slept in a meeting although the discussion has been far from boring?
  2. Do you suffer from chest-pains from hitting the steering wheel too often when dozing off while driving? (No, I’m serious!)
  3. Has your spouse commented that he/she had to rouse you up when you were sleeping at night  because he/she noticed you had apparently stopped breathing?
  4. Has your blood pressure been difficult to control despite being put on many different anti-hypertensive medications?

What do the above conditions have in common? They belong to patients who have presented  with various manifestations of obstructive sleep apnoea (OSA) -breathing pauses during sleep caused by obstruction of the upper breathing passages. To understand better, watch this video:

This relatively newly-recognised situation has in fact been around for ages, but it has been only recently that doctors have accepted this as a separate condition with profound life-threatening complications.

While more common in the obese and middle-aged, others may present with symptoms such as:

  • snoring
  • choking while sleeping
  • daytime sleepiness (at meetings and at the wheel)
  • morning headaches
  • poor memory, depression, irritability,sexual impotence

So what’s the big deal?

Well, apart from the fact that OSA causes excessive sleepiness and tiredness and is a health hazard at work or on the road (to others as well!) , it has now been linked to a host of other conditions:

  • increased risk of heart attacks, strokes and death
  • high blood pressure resistant to most medications
  • brain-cell damage due to lack of oxygen

The good thing is something can be done about it, using latest techniques.

For instance, to diagnose this condition, people used to need to stay in hospital’s sleep lab to undergo a sleep study (polysomnogram). Nowadays, portable devices are available (even in Malaysia) where one just needs to wear this device and have the recording in the comfort of your own bed.

In terms of treatment, a whole host of new methods are available apart from the traditional C-PAP mask that is quite inconvenient to use. In fact, one of the most effective forms of treatment is to just lose weight!

Two points are worth noting:

  1. Inform your surgeon if you are going for surgery as OSA patients can sufffer from prolonged absent breathing periods (apnoea) and may suffer complications following anaesthesia.
  2. Snoring does not equal OSA. A lot of people snore but they do not stop breathing for more than 10 secs while asleep.This is quite normal.

Health Alert (3): Bovril recalled by Maker for Suspected Contamination

Bovril beef

Unilever in the UK, the makers of that world-renowned thick salty beef extract, Bovril, has recalled some 15,000 jars today after routine checks of their jars revealed traces of the bacteria Salmonella, (one of the causes of food poisoning) reports BBC News. This revelation comes closely to the unrelated recent outbreak of Salmonella in the USA which has been attributed to contaminated chilli peppers.

Bovril is a popular ‘beef tea’ drink especially in France, Spain, Malaysia, Singapore and China and is solely manufactured in the UK at its factory in Burton upon Trent, Staffordshire. It has been drunk by generations and is featured also as a popular ingredient in many local recipes.

Unilever says the recalled jars only affect those with best-before-end date of January 2010 with batch codes of L8201XX795, L8206XX795, L8207XX795, L8208XX795 and L8207XX795.

So far, it is not known whether any of the affected batches have found their way overseas.

Beijing Olympics Face Major Health Issues, including Doping (part 3) – “Technology Doping”

USA's Katie Hoff in action - a combination of athletism, advanced pool technology and state-of-the-art swimsuit

Ever wondered why the swimming world records are tumbling like 10-pins at the Water-Cube?

True, advanced training methods and legal food supplements have produced more physically fit swimmers. But today’s swimmers are not as formidable-looking as the East Germans in the 1970s who were being pumped with anabolic steriods.

Various columnists have pointed out to several other reasons. Firstly, the swimming-pool itself. Fitted with 2 additional lanes on top of the standard 8 lanes, the outer two lanes are left empty to absorb the waves created by turbulence so that the water is as still as possible. On top of that, the waves are dispersed into gutters which are at the level of the water surface. Why, even the plastic buoys that separate the lanes are designed to push the force of waves downwards. Not forgetting of course, that the pool is 3 metres deep(instead of 2), to lessen resistance. And the non-skid starting blocks..which are designed for enhanced take-off.

"It literally feels like a rocket coming off the wall," said Phelps, "The water just runs off the suit."

Undoubtedly, the talking point is on the latest full-body suit, the Speedo LZR Racer. The corsetlike suit requires a half-hour to put on  and is made by ultrasonic welding instead of stitching. It is designed to mould the body into a streamlined configuration. It is said to assist the act of breathing as well as enhancing one’s buoyancy in water.

So much so, the Italian swimming coach (that uses a rival brand – Arena) has alleged that these suits have violated performance-enhancing rules set by the international swimming federation(FINA) and equates the usage of these suits as “technological doping”.

Doping or not, you cannot prevent the application of such legalised technology in sport.

Food for Your Thoughts..

“One quarter of what you eat keeps you alive.  The other three-quarters keeps your doctor alive”.

(Hieroglyph found in an ancient Egyptian tomb.)

Its amazing how some beliefs have withstood the test of time!

Health Alert(2): Herbal Supplements Interfere With Success of Surgery

Before undergoing surgery, one important info which must be disclosed to your doctor is whether you are taking herbal supplements. This is often left out by patients when doctors enquire on what medications they are taking, as often many people do not equate medicines with supplements.

Many intensive care physicians including anaesthesiologists will tell you of their experience with patients who take a long time to wake up after surgery; develop fits upon recovery or bleed excessively after surgery; all due to the taking of herbals.

Incidents like the above used to mystify many doctors previously but evidence is now clear that several over-the- counter supplements can interfere with the various actions of medications used during surgery.

Take a look below at some common examples:

Herbal supplement Possible complications
Aloe vera May cause increased intestinal muscle movement to digest food (peristalsis), may decrease effectiveness of water pills (diuretics) given after surgery
Bromelain May cause bleeding or interact with antibiotics such as amoxicillin or tetracyclines
Danshen May cause bleeding
Dong quai May cause bleeding
Echinacea May interfere with immune functioning, may alter effectiveness of immunosuppressant drugs given after transplant surgery
Ephedra May cause abnormal heartbeat, may cause extreme high blood pressure and coma if combined with certain antidepressants and anesthesia
Feverfew May cause bleeding
Garlic May cause bleeding, may interfere with normal blood clotting
Ginger May cause bleeding
Ginkgo May cause bleeding
Ginseng May cause bleeding, may cause rapid heartbeat, may cause high blood pressure
Goldenseal May cause or worsen swelling and high blood pressure
Kava May enhance sedative effects of anesthesia
Licorice (not including licorice candy) May increase blood pressure
Omega-3 fatty acids May cause bleeding if taken in doses greater than 3 grams a day
Senna May cause electrolyte imbalance
St. John’s wort May increase or decrease the effects of some drugs used during and after surgery
Valerian May prolong the effects of anesthesia
Primrose plant

Evening primrose oil-stop taking this 2 weeks before surgery

The above list is not exhaustive. As more cases are encountered, the list gets longer!
Evening Primrose Oil (EPO) is now implicated in the cause of fits or seizures following general anaesthesia.
Some points to note if you are undergoing planned surgery:
  1. Remember that the list of medications that you need to reveal to your doctor includes all supplements, whether as pills or as a drink.
  2. Some of these herbals may have to be stopped more than 2 weeks prior to planned surgery.
  3. In emergency surgery, remember to reveal to your doctor and next-of-kin what you are taking so that some preventive measures may be undertaken beforehand by the doctors.
4.  People believe if something is natural, it is safe. That is not necessarily true. If in doubt, show your
care-giver the original container of the supplement.
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